Balloon Aortic Valvuloplasty in The Transcatheter Valve Era: Single Centre Indications And Early Safety Data in A High Risk Population

• Published in: Heart, lung & circulation lung & circulation, 2018-05, Vol.27 (5), p.595-600
• Main Authors: Ford, Thomas J., MBChB, Nguyen, Katherine, MBBS, Brassil, Joseph, MBBS, Kushwaha, Virag, MBBS, PhD, Friedman, Daniel, MBBCh, Allan, Roger, MBBS, Pitney, Mark, MBBS, Jepson, Nigel, MBBS
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Balloon aortic valvuloplasty; Cardiovascular; Heart failure
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2017.05.128

Background The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. Methods We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. Results Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88 ± 5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22% ± 14.5%). Indications for BAV included palliation of symptoms n = 42 (76%); bridge to definitive valve replacement (n = 6, 11%); and evaluation of response (n = 6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24 hours) and low 30-day mortality at 3.9% (n = 2). Minor vascular complications occurred in 11.8% (n = 6), whilst permanent pacemaker implantation was required in 5.8% (n = 3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. Conclusions Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.